Factors Associated with Unplanned Early Discharges from a Dual Diagnosis Inpatient Detoxification Unit in Israel.

OBJECTIVES: Currently, Israel has a single governmental inpatient dual diagnosis detoxification unit. We provide a cross-section of patient profiles in this study as well as explore possible associations between clinical/demographic factors and the unplanned early discharge of patients from the unit, aiming at improving rehabilitation success rates. METHODS: In this retrospective study, medical records of all patients admitted to the unit between January 1, 2012, and July 1, 2013, were examined (N = 323). ICD-10 was used for diagnosis. Statistical analysis was carried out using Pearson's chi-squared test and binary logistic regression. RESULTS: Patients admitted to our unit were affected by schizophrenia (31.8%), personality disorder (25%), and depression (18.3%). Substances in use included alcohol (67.5%), cannabis (8.35%), and benzodiazepines (9%). Almost half of the patients were polysubstance users (48.9%). The unit had high rates of immigrants, mainly ex-USSR- and Ethiopian-born. It had low rates of individuals who had served in the army (52.8%), despite the service being mandatory in Israel. Sixty-eight percent of patients completed the program as planned, and 32% were discharged early: 8.6% discharged due to drug use in detoxification settings, violence, or hospitalization for clinical reasons and 23.2% discharged against medical advice. Immigrants had increased rates of completing the program as scheduled. Of the 46.7% of patients with severe mental illness, 44.3% were discharged early. Higher education and a diagnosis of depression were associated with program completion as planned. Using logistic regression, we found that patients with disability pensions (odds ratio [OR] = 0.36; 95% confidence interval [CI] [0.14-0.91]; p = .03) and polysubstance use (OR = 0.39; 95% [CI] [0.23, 0.66], p < .001) had a higher risk of early discharge. Upon completion of individual programs, 52% were referred to an ambulatory addiction center and 13% to a nationally sponsored dual diagnosis therapeutic community. CONCLUSIONS: Israel's single official dual diagnosis detox inpatient unit has satisfactory annual program completion rates when compared to similar institutions. A suboptimal treatment regimen may contribute to the early discharge of patients with polysubstance use and diagnosed personality disorders. An association between early discharges and a disability pension warrant further investigation, as there is no apparent connection between the two.

Dysfunctional personality traits in adolescence: effects on alerting, orienting and executive control of attention.

The present study examined attentional networks performance in 39 adolescents with dysfunctional personality traits, split into two group, Group < 10 and Group ≥ 10, according to the number of criteria they met at the Structured Clinical Interview for DSM-IV Axis II Personality Disorders. The attentional performance has been tested by means of a modified version of the Attentional Network Test (ANTI-V) which allows testing both phasic and tonic components of the alerting system, the exogenous aspect of the orienting system, the executive network and their interactions. Results showed that the orienting costs of having an invalid spatial cue were reduced in the Group ≥ 10 criteria compared to the Group < 10. Moreover, adolescents included in the Group ≥ 10 showed lower conflict when attention was cued to the target location (valid trials) but showed normal interference when there was no overpowering focus of attention (invalid trials). The results found with ANOVA after splitting the sample into two categorical groups were also observed in a complementary correlation analysis keeping intact the continuous nature of such variables. These findings are consistent with the notion that dysfunctional features of personality disorders may represent the psychological manifestations of a neuropsychological abnormality in attention and executive functioning. Finally, we discuss the implications of this attentional anomaly for dysfunctional personality traits and behaviour.

EXPLORING PERSONALITY DIAGNOSIS STABILITY FOLLOWING ACUTE PSYCHOTHERAPY FOR CHRONIC POSTTRAUMATIC STRESS DISORDER.

BACKGROUND: Axis I comorbidity complicates diagnosing axis II personality disorders (PDs). PDs might influence Axis I outcome. No research has examined psychotherapy effects on PDs of treating Axis I comorbidity. Secondary analysis of a randomized controlled trial examined PD diagnostic stability after brief psychotherapy of chronic posttraumatic stress disorder (PTSD). METHODS: Patients with chronic PTSD were randomly assigned to 14 weeks of prolonged exposure, interpersonal psychotherapy, or relaxation therapy. Assessments included the Structured Clinical Interview for DSM-IV, Patient Version (SCID-P) and Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II) at baseline, week 14, and for treatment responders (≥30% clinician-administered PTSD scale improvement, defined a priori) at week 26 follow-up. We hypothesized patients whose PTSD improved would retain fewer baseline PD diagnoses posttreatment, particularly with personality traits PTSD mimics, e.g. paranoid and avoidant. RESULTS: Forty-seven (47%) of 99 SCID-II patients evaluated at baseline received a SCID-II diagnosis: paranoid (28%), obsessive-compulsive (27%), and avoidant (23%) PDs were most prevalent. Among 78 patients who repeated SCID-II evaluations posttreatment, 45% (N = 35) had baseline PD diagnoses, of which 43% (N = 15/35) lost at week 14. Three (7%) patients without baseline PDs acquired diagnoses at week 14; 10 others shifted diagnoses. Treatment modality and PTSD response were unrelated to PD improvement. Of treatment responders reevaluated at follow-up (N = 44), 56% with any baseline Axis II diagnosis had none at week 26. CONCLUSION: This first evaluation of Axis I psychotherapy effects on personality disorder stability found that acutely treating a chronic state decreased apparent trait-across most PDs observed. These exploratory findings suggest personality diagnoses may have limited prognostic meaning in treating chronic PTSD.

[Massage with aromatherapy: effectiveness on anxiety of users with personality disorders in psychiatric hospitalization]. / Massagem com aromaterapia: efetividade sobre a ansiedade de usuárioscom transtornos de personalidade em internação psiquiátrica.

OBJECTIVE: To investigate the effectiveness of aromatherapy massage using the essential oils (0.5%) of Lavandula angustifolia and Pelargonium graveolens for anxiety reduction in patients with personality disorders during psychiatric hospitalization. METHOD: Uncontrolled clinical trial with 50 subjects submitted to six massages with aromatherapy, performed on alternate days, on the cervical and the posterior thoracic regions. Vital data (heart and respiratory rate) were collected before and after each session and an anxiety scale (Trait Anxiety Inventory-State) was applied at the beginning and end of the intervention. The results were statistically analyzed with the chi square test and paired t test. RESULTS: There was a statistically significant decrease (p < 0.001) of the heart and respiratory mean rates after each intervention session, as well as in the inventory score. CONCLUSION: Aromatherapy has demonstrated effectiveness in anxiety relief, considering the decrease of heart and respiratory rates in patients diagnosed with personality disorders during psychiatric hospitalization.

Massage with aromatherapy: effectiveness on anxiety of users with personality disorders in psychiatric hospitalization / Masaje Con Aromaterapia: Efectividad Sobre La Ansiedad De Usuarios Con Trastornos De Personalidad En Hospitalización Psiquiátrica / Massagem com aromaterapia: efetividade sobre a ansiedade de usuários com transtornos de personalidade em internação psiquiátrica

OBJECTIVE To investigate the effectiveness of aromatherapy massage using the essential oils (0.5%) of Lavandula angustifolia and Pelargonium graveolens for anxiety reduction in patients with personality disorders during psychiatric hospitalization. METHOD Uncontrolled clinical trial with 50 subjects submitted to six massages with aromatherapy, performed on alternate days, on the cervical and the posterior thoracic regions. Vital data (heart and respiratory rate) were collected before and after each session and an anxiety scale (Trait Anxiety Inventory-State) was applied at the beginning and end of the intervention. The results were statistically analyzed with the chi square test and paired t test. RESULTS There was a statistically significant decrease (p < 0.001) of the heart and respiratory mean rates after each intervention session, as well as in the inventory score. CONCLUSION Aromatherapy has demonstrated effectiveness in anxiety relief, considering the decrease of heart and respiratory rates in patients diagnosed with personality disorders during psychiatric hospitalization. .

OBJETIVO Investigar la efectividad del masaje con aromaterapia utilizando aceites esenciales de Lavandula angustifolia y Pelargonium graveolens (0,5%) para la disminución de la ansiedad de pacientes con Trastornos de Personalidad durante la estancia en hospital psiquiátrico. MÉTODO Ensayo clínico no controlado con 50 sujetos sometidos a seis masajes con aromaterapia, realizados en días alternados, en la región cervical y torácica posterior. Fueron recogidos datos vitales (frecuencias cardiaca y respiratoria) antes y después de cada sesión y se aplicó una escala sobre ansiedad (Inventario de Ansiedad Estado-Rasgo), en el inicio y término de la intervención. Los resultados fueron analizados estadísticamente mediante la prueba t pareada y de chi cuadrado. RESULTADOS Hubo disminución estadísticamente significativa (p<0,001) de los promedios de las frecuencias cardiaca y respiratoria tras cada sesión de intervención, así como en el puntaje del inventario. CONCLUSIÓN La aromaterapia demostró ser efectiva en el alivio de la ansiedad, considerando la reducción de las frecuencias cardiaca y respiratoria en pacientes diagnosticados con trastornos de la personalidad durante la hospitalización psiquiátrica. .

OBJETIVO Investigar a efetividade da massagem com aromaterapia utilizando óleos essenciais de Lavandula angustifolia e Pelargonium graveolens (0,5%) para diminuição da ansiedade de pacientes com Transtornos de Personalidade durante a internação psiquiátrica. MÉTODO Ensaio clínico não controlado com 50 sujeitos submetidos a seis massagens com aromaterapia, realizadas em dias alternados, na região cervical e torácica posterior. Foram coletados dados vitais (frequências cardíaca e respiratória) antes e após cada sessão e foi aplicada uma escala sobre ansiedade (Inventário de Ansiedade Traço-Estado), no início e término da intervenção. Os resultados foram analisados estatisticamente com o teste t pareado e qui-quadrado. RESULTADOS Houve diminuição estatisticamente significativa (p<0,001) das médias das frequências cardíaca e respiratória após cada sessão da intervenção, assim como na pontuação do inventário. CONCLUSÃO A aromaterapia demonstrou ser efetiva no alívio da ansiedade, considerando a diminuição das frequências cardíaca e respiratória em pacientes diagnosticados com transtornos da personalidade durante a internação psiquiátrica. .

The clinical, forensic and treatment outcome factors of patients with autism spectrum disorder treated in a forensic intellectual disability service.

BACKGROUND: To describe the characteristics of those with autism spectrum disorder (ASD) treated within a forensic intellectual disability hospital and to compare them with those without ASD. METHOD: Service evaluation of a cohort of 138 patients treated over a 6-year period. RESULTS: Of the 138, 42 had an ASD. Personality disorders and harmful use or dependence on drugs were significantly lower in the ASD group. The ASD group was less likely to be subject to criminal sections or restriction orders. Self-harm was significantly higher in the ASD group. There were no differences in the length of stay and direction of care pathway. CONCLUSIONS: Although the ASD and non-ASD groups differ on clinical and forensic characteristics, their treatment outcomes appear similar. This suggests that the diagnostic category of ASD alone may be inadequate in predicting the treatment outcome. There is a case to identify distinct typologies within the ASD group.

Existential dynamic therapy ("VITA") for treatment-resistant depression with cluster C disorder: matched comparison to treatment as usual.

Existential suffering may contribute to treatment-resistant depression. The "VITA" treatment model was designed for such patients with long-standing depression accompanied by existential and/or religious concerns. This naturalistic effectiveness study compared the VITA model (n = 50) with a "treatment as usual" comparison group (TAU; n = 50) of patients with treatment-resistant depression and cluster c comorbidity. The TAU patients were matched on several characteristics with the VITA patients. The VITA model included existential, dynamic, narrative and affect-focused components. The VITA group had significantly greater improvement on symptom distress and relational problems during treatment and from pre-treatment to 1-year follow-up. Patients in the VITA, at follow-up, were more likely to be employed and less likely be using psychotropic medications.

Fibromialgia y trastornos de personalidad / Fibromyalgia and personality disorders

Introducción. El objetivo es detectar, en atención primaria, posibles alteraciones de personalidad en pacientes con fibromialgia, que indiquen la valoración por el servicio de salud mental. Material y métodos. Estudio descriptivo transversal, en un ámbito urbano de atención primaria. Población de estudio: la totalidad de personas diagnosticadas de fibromialgia registradas en historia clínica informatizada, mayores de 18 años. Cumplieron criterios de selección 132 casos. Se recogieron variables sociodemográficas y clínicas y se administró el test Internacional Personality Disorder Examination screening (IPDE-s). Resultados. El 100% de los pacientes eran mujeres, con edad media de 54 años. Casadas/en pareja el 78,5%, no trabajaban el 89,2% y pertenecían a clase social baja el 58,7%. Refirieron enfermedad mental el 73,6% de casos, siendo este diagnóstico previo al de fibromialgia en un 55,1%. El diagnóstico psiquiátrico más frecuente fue el trastorno de ánimo (86,3%). La autopercepción de salud fue regular-mala en el 87,6% y la expectativa de curación favorable en solo un 18,2%. Resultados. El IPDE-s fue positivo en el 96,7% de casos; en el 94,2% además, a más de un rasgo de personalidad. Rasgos más prevalentes: límite 71,9%, obsesivo 71,1%, histriónico 66,1% y evitación 61,9%. Se encontró relación significativa entre padecer patología psiquiátrica y rasgo de personalidad límite o dependiente (p<0,006; p<0,03 respectivamente); así como entre una peor percepción de salud y rasgo dependiente (p<0,004). Conclusiones. Se detecta una alta sospecha de rasgos de personalidad anómalos en pacientes diagnosticadas de fibromialgia, que justificaría la derivación para un estudio/seguimiento más completo por salud mental (AU)

Introduction. The aim is to detect possible personality disorders in subjects with fibromyalgia in a Primary Care centre who have been assessed by the Mental Health Department. Material and methods. A cross-sectional descriptive study in an urban Primary Care centre. All patient diagnosed with fibromyalgia with a computerised clinical history, and over 18 years were included. A total 132 cases fulfilled the selection criteria. The main measurements were social, demographic and clinical variables, and the International Personality Disorder Screening Examination (IPDE-s). Results. All the cases (100%) were women and the average age was 54 years. Married or in couple (78.5%), did not work (89.2%) and from a low social class (58.7%). Mental illness was detected in 73.6% of cases, and in 55.1% of them its diagnosis was prior to fibromyalgia. Mood disorders (86.3%) were the most frequent diagnosis. Self perception of health was regular-bad in 87.6% of cases and the healing expectation 18.2%. Results. The IPDE-s was positive in 96.7% of the sample and more than one personality disorder detected in 94.2%. The more frequent personality disorders were: histrionic 71.9%, obsessive 71.1%, emotionally unstable 66.1%, and avoidance 61.9%. Significant relationships were found between suffering psychiatric disease and having personality traits of unstable emotions or dependency (P<0.006; p<0.03 respectively). As well between a self-perception of poorer health and dependent personality (P<0.004). Conclusions. The high rate of abnormal personality disorders in patients with fibromyalgia requires a more comprehensive study and holistic approach (AU)

Psychosomatic medicine.

Psychosomatic medicine may be defined as a comprehensive, interdisciplinary framework for: assessment of psychological factors affecting individual vulnerability as well as course and outcome of illness; biopsychosocial consideration of patient care in clinical practice; specialist interventions to integrate psychological therapies in the prevention, treatment and rehabilitation of medical disease. The aim of this review was to provide an updated definition of psychosomatic medicine, to outline its boundaries with related disciplines and to illustrate its main contributions to clinical and preventive medicine. A review of the psychosomatic literature, using both Medline and manual searches, with particular reference to articles, which could be relevant to clinical practice, was performed. Current advances in the field have practical implications for medical research and practice, with particular reference to the role of lifestyle, the challenge of medically unexplained symptoms, the psychosocial needs entailed by chronic illness, the appraisal of therapy beyond pharmaceutical reductionism, the function of the patient actively contributing to his/her health. Today, the field of psychosomatic medicine is scientifically rigorous, more diversified and therapeutically relevant than ever before.

[Self-harm and personality disorders]. / Selvskading og personlighetsforstyrrelser.

BACKGROUND: Clinical experience and recent research convey that patients with personality disorders who harm themselves with a suicidal intention should be treated differently than those who do so without a suicidal intention. The purpose of this article is to give an overview of non-suicidal self-harm in these patients. MATERIAL AND METHOD: The article is based on a non-systematic literature search in PsycINFO, Medline, Clinical Evidence and Cochrane and own clinical experience. RESULTS: Self-harm in patients with personality disorders is associated with borderline personality traits. Up to 70 % of patients with borderline personality disorders have reported non-suicidal self-harm. Non-suicidal self-harm is one of the risk factors for suicide. Borderline personality disorder develops due to interaction between genetic vulnerability and a traumatic and unsafe upbringing. The patients are often influenced by intense negative emotions and have reduced ability to regulate and handle these in interpersonal situations. Self-harm can give short-term alleviation of the inner pain associated with emotion dysregulation. Dialectical behavior therapy and mentalization-based therapy is shown to reduce the prevalence of self-harm in patients with borderline personality disorder. Acute referral to in-patient treatment should only be used in crises that cannot be handled in out-patient treatment. The regular general practitioner can function as a stable attachment figure and contribute to self-regulation. INTERPRETATION: Non-suicidal self-harm in patients with personality disorders should be given more attention.

Are personality traits of juvenile myoclonic epilepsy related to frontal lobe dysfunctions? A proton MRS study.

PURPOSE: Personality traits characterized by emotional instability and immaturity, unsteadiness, lack of discipline, hedonism, frequent and rapid mood changes, and indifference toward one's disease have been associated with patients who have juvenile myoclonic epilepsy (JME). Literature data demonstrate worse seizure control and more psychosocial dysfunctions among patients with JME who have those traits. In this controlled study we performed a correlation analysis of psychiatric scores with magnetic resonance spectroscopy (MRS) values across JME patients, aiming to verify the existence of a possible relation between frontal lobe dysfunction and the prevalence of personality disorders (PDs) in JME. METHODS: Sixteen JME patients with cluster B PDs, 41 JME patients without any psychiatric disorder, and 30 healthy controls were submitted to a psychiatric evaluation and to a quantitative multivoxel MRS of thalamus; insula; cingulate gyrus; striatum; and frontal, parietal, and occipital lobes. Groups were homogeneous according to age, gender, and manual dominance. Psychiatric evaluation was performed through the Scheduled Clinical Interview for DSM-IV, Axis I and II (SCID I and II, respectively). RESULTS: A significant reduction of N-acetyl-aspartate over creatinine (NAA/Cr) ratio was observed mainly in the left frontal lobe in the JME and PD group. In addition, a significant increase in the glutamate-glutamine over creatinine GLX/Cr ratio was also observed in this referred region in the same group. DISCUSSION: These data support the hypothesis that PDs in JME could represent neuronal dysfunction and possibly a more severe form of this epileptic syndrome.

[Psychotherapeutic day treatment of patients with severe personality disorders. Results from the first two years]. / Psykoterapeutisk dagbehandling af svaert personlighedsforstyrrede patienter. En toårsopgørelse.

INTRODUCTION: A psychotherapeutic day treatment (DT) for patients with severe personality disorders (PD) was established in January 2003, consisting of five months of intensive psychodynamic based integrated therapy for 14 patients. This paper presents results from the first two years. MATERIAL AND METHODS: 53 patients were included in a five month combined group psychotherapeutic DT, including psychoeducation, cognitive, body, music/drawing and individual therapy. Semi-structured interviews were used to assess diagnosis (PSE, SCID-II). SCL-90-R, self-rating scales and GAF rating (s/f) were used before and after therapy. The design was naturalistic. RESULTS: 40 patients (34 women) completed the DT. Eight dropped out and five received another treatment. Before treatment: Average age 27(SD 6,5), mean GAF= 43 corresponding with unemployment, singles and social dysfunctions, high degree of self mutilation, suicide attempts, earlier hospitalisations and substance abuse. The most frequent diagnosis was borderline disorder 63%. There were co-morbidity with anxiety disorder 48% and depression 22%. Most importantly, we found a significant reduction in symptoms, significant increase in the level of function, reduction in self destructive behaviour, a pronounced reduction in hospitalisations and a relatively high degree of satisfaction with the treatment programme. CONCLUSION: According to literature, effective treatment of patients with severe PD has to be long term, integrated, theoretical coherent and focused on compliance. Our study indicates that the intensive DT is effective and a good introduction to long term psychotherapy.

Validación del Cuestionario de Variables de Interacción Psicosocial (VIP): hacia un modelo de tratamiento de las conductas adictivas «guiado por la personalidad» / Validation of the Psychosocial Interaction Variables Questionnaire: towards a «personality guided therapy» model of addiction treatment

Objetivo: La personalidad puede estudiarse a 3 niveles: el clínico (trastornos), el de rasgos y el nivel de variables interaccionales. Hay instrumentos válidos para la medida de los 2 primeros, pero no disponemos de alguno que explore de forma conjunta el nivel interaccional. Proponemos un modelo de tratamiento de las conductas adictivas «guiado por la personalidad» en la línea propuesta por Millon para los trastornos del eje II, que se basa en la función que cumple la droga con relación al patrón de personalidad general. El objetivo del estudio ha sido diseñar y validar un cuestionario que explore de forma adecuada y sencilla un cierto número de variables de interacción psicosocial en los individuos que realizan tratamiento por abuso o dependencia de sustancias. Escogemos como variables: autoestima, autoeficacia general, optimismo, locus de control, habilidades sociales, autocontrol y estilos de afrontamiento del estrés. Material y métodos: Se describe el proceso de creación del Cuestionario de Variables de Interacción Psicosocial (VIP), hasta alcanzar su forma definitiva, con 84 ítems. Se validó sobre una muestra de 776 sujetos, 569 en tratamiento por abuso/dependencia de heroína, cocaína, alcohol, cannabis, benzodiazepinas y ludopatía, y 197 sujetos de población general. Resultados: Todos los participantes cumplimentan el VIP y diversos cuestionarios complementarios para el estudio de validez. La consistencia interna global es de 0,93 y la de las escalas que lo componen se sitúa entre 0,82 y 0,91, salvo las de afrontamiento centrado en la búsqueda de apoyo social (5 ítems), 0,78, y la de locus de control (3 ítems), 0,65. La consistencia temporal de las escalas (entre 4 y 6 semanas) es de 0,92 para población general y de 0,80 para sujetos sometidos a tratamiento. Se estudia la validez aparente, de contenido, de constructo, convergente y discriminante, que resultan adecuadas. Las escalas del VIP predicen una media del 45% de la varianza de los síndromes clínicos del eje I y el 33% de los patrones de personalidad patológica (alcanzando más del 50% en 5 de ellos) estimados mediante el MCMI-II. Conclusiones: Consideramos que el VIP es un instrumento de utilidad para el estudio de las variables nucleares de la personalidad, que permite la comprensión del valor funcional de la conducta adictiva con relación al patrón general de comportamiento de los sujetos, y puede facilitar el diseño y evaluación de los tratamientos específicos, aunque se puede aplicar en otros ámbitos

Objective: The personality can be studied at three levels: clinical (disorders), traits and the level of interactive variables. There are valid instruments for the measurement of both first, but we do not have any that explores in a combined way the interactional level. We propose a model of «personality guided treatment» for the addictive behaviours in the direction of the one proposed by Millon for axis II disorders, based on function of drug in relation to its personality pattern. The aim of the study is to design and validation of a questionnaire that explores in a suitable and simple way a certain number of psycho-social interaction variables in the individuals that are in treatment by abuse/dependency of substances and gambling. We choose as variables: self-esteem, general self-efficacy, optimism, locus of control, social abilities, self-control and coping styles. Material and methods: It is described the creation process of the Questionnaire of Variables of Psycho-social Interaction (VIP), until reaching its definitive form, with 84 items. We validate on a sample of 776 subjects, 569 in treatment by abuse/dependency of heroin, cocaine, alcohol, cannabis, benzodiazepines and compulsive gambling; and 197 subjects of general population. Results: All participants compliment the VIP and diverse complementary questionnaires for the validity study. The global internal consistency is 0.93 and the one of the scales that compose it locates between 0.82 and 0.91, except for those of coping oriented to search of social support (5 items), 0.78; and the one of locus of control (3 items), 0.65. The temporary consistency of the scales (between 4 and 6 weeks) is 0.92 for general population and 0.80 for subjects in treatment. The apparent, content, convergent and discriminative and construct validity studies, are suitables. The scales of the VIP predict an average of 45% of the variance of the clinical syndromes of axis I, and 33% of pathological personality patterns (reaching more of 50% in 5 of them) considered by means of the MCMI-II. Conclusions: We considered that the VIP is an instrument of utility for the core personality variables study, that allows the understanding of functional value of the addictive behaviours in relation to the persons general behaviour pattern, and can facilitate the design and evaluation of the specific treatments, although can be applied in other scopes

Attention processes in the maintenance and treatment of social phobia: hypervigilance, avoidance and self-focused attention.

Four domains of evidence regarding the relationship between attention and social phobia are reviewed: (1) possible maintaining factor, (2) causal relationship, (3) specific relationship and (4) mediator of change during treatment. Two areas of research are covered and integrated: vigilance-avoidance of social threat stimuli and self-focused attention. There is empirical support for these processes as possible maintaining factors that are specific to patients and non-clinical samples with high levels of social anxiety. There is reasonable evidence to promote the use of attentional strategies in the treatment of social phobia, although better controlled studies are required. We propose six overlapping mechanisms that could be responsible for change: reduced vigilance; reduced avoidance; reduced self-focused attention; mindfulness; increased attentional control; increased self-esteem.

Trastorno por déficit de atención e hiperactividad y su relación con rasgos y trastornos de personalidad en consumidores de drogas en tratamiento: estudio del WURS y su relación con el BFQ y el MCMI-II. Una visión crítica / Attention deficit hyperactivity disorder and its relationship with personality disorders and traits in drug consumers under treatment: WURS study and its relationship with the BFQ and the MCMI-II. A critical view

Objetivo: Estudiar la relación entre la posible existencia de trastorno por déficit de atención e hiperactividad (TDAH) en el pasado de sujetos en tratamiento por consumo problemático de drogas, y su relación con los rasgos y trastornos de la personalidad en el momento actual. Estimar la posible funcionalidad de las drogas con relación a los rasgos y la psicopatología actual y precedente. Estudiar el empleo del Wender Utah Rating Scale (WURS) como instrumento diagnóstico retrospectivo. Material y método: Administramos el WURS (versión de 25 ítems propuesta por los autores), el Big Five Questionnaire (BFQ) y el Millon Clinical Multiaxial Inventory (MCMI-II) a una cohorte de 175 pacientes que inician tratamiento en un centro ambulatorio de atención a drogodependencias. Tras descartar a aquellos que distorsionaron significativamente los cuestionarios, queda una muestra de 152 pacientes que inician tratamiento por consumo de heroína (48), cocaína (60), alcohol (34), cannabis (9) y benzodiazepinas (1). Los cuestionarios se cumplimentan una vez se produce la estabilización de los pacientes (inexistencia de síntomas y signos de intoxicación o de abstinencia). Resultados: El 47 por ciento de los pacientes supera el punto de corte de 36 propuesto en estudios previos. El análisis factorial del WURS nos proporciona una solución de 3 factores: emocionalidad negativa, impulsividad / problemas de conducta e inatención / problemas de aprendizaje. El primero de ellos no hace relación a ninguno de los criterios diagnósticos DSM-IV ni CIE-10, y es el que explica la mayor parte de la varianza. Las relaciones entre WURS y BFQ no son las esperables a partir de la fundamentación psicobiológica del TDAH y de los rasgos de personalidad. Las relaciones entre WURS y MCMI-II se explican mejor a partir de los componentes emocional e impulsivo del primero, que por la supuesta combinación propia del TDAH. Apreciamos sesgos importantes en la cumplimentación del WURS, como la focalización de la memoria en fases del desarrollo que no se corresponden con las definidas para el TDAH. Conclusiones: Cuestionamos la especificidad del WURS para detectar retrospectivamente el TDAH, tal y como éste se define por criterios y psicobiológicamente. Sugerimos que la inclusión de la escala de emocionalidad negativa incrementa de forma espuria la prevalencia de este trastorno en la muestra y que los sujetos responden atendiendo a recuerdos de edades próximas a la adolescencia, lo que permite explicar las elevadas puntuaciones en el WURS a partir de hipótesis alternativas (AU)

Personality profiles of patients with dissociative trance disorder in Singapore.

This report studies the personality of individuals who suffer from dissociative trance disorder and examines whether the personality profiles could predict the individual's frequency of trance states. A total of 58 cases were given the Eysenck Personality Questionnaire (EPQ) and their personal information harvested from the case notes and through subsequent interviews. The subjects were also reassessed 1 year later to obtain their frequency of trance states. For both sexes, there were lower extraversion scores and higher psychoticism, neuroticism, and lie scores in the sample compared to the Singapore norms. Of the 47 subjects traced, total episodes of trances that occurred over the 1-year period was positively correlated with neuroticism and negatively with extraversion scores. The high lie scores in individuals with dissociative trance disorder could be a reflection of their concern of how others perceive them. The motivation could be that of restoration of self-esteem or "face." The profiles in the EPQ could be used to predict the individual's frequency of trance states. Subjects with personality traits like nervousness, excitability, and emotional instability were more likely to have a higher frequency of trance states.

Sexual predators.

Social responses to sex-offending behaviors have included criminal sanctions and clinical interventions that have evolved over time. These developments have created various challenges for mental health professionals charged with providing care to offenders, particularly when legislative expectations have exceeded available treatments. A summary is provided of recent clinical developments in assessments, therapies, and pharmacology. The usefulness of SRIs, in particular, may prompt the involvement of more psychiatrists in this treatment. Other implications for future practice of these clinical and legal developments are also discussed.